Organ Transplant: Costs associated with the location of a replacement organ. Or any costs incurred for the removal of
the organ from the donor, or cost for the organ itself. AHO also will not cover all costs of administration and
transportation of the organ. Costs of removing an organ from the member for transplantation into another person.
Transplants involving mechanical or animal organs. Stem cell storage, or harvesting, when these cells will be used in
possible future illness or disease.
Over the Counter Medication: such as vitamins, or pain tablets, or ointments, or supplements that do
not require a prescription to be purchased.
Performance Enhancement: Any medication or treatment that is related to a desired change or
improvement of performance or behavior.
Pre-Existing Medical Conditions: Medical Expenses for a Pre-existing Medical Condition or related
condition for which the Insured Person has received or needed treatment, or medication, or sought
advice for the said condition at any time prior to joining Alliance Health Options. Any Pre-existing
Medical Conditions as defined unless otherwise declared on the Application Form and expressly
confirmed acceptance by Alliance Health Options. Except where the member has been given a $5000
lifetime limit for EMERGENCIES relating to specifically mentioned medical conditions. This includes
every condition that the Medical Advisory Board of AHO determines were in existence at or prior to your
join date. Please see benefit #57.
Pregnancy Terminations: Where non-medically necessary.
Pregnancy, Conception, Childbirth and Post-natal costs whether normal or complicated, including the
transfer of a pregnant woman to hospital to give routine childbirth or air travel when the Insured Person
is more than 28 weeks pregnant, unless cover is provided under the Optional Maternity Benefit as
shown in the Insured Person’s Certificate of Insurance. Please see benefits #61 to 67.
Prophylactic or Preventative Treatment: The costs of surgery, or treatment, or service, or dietary
supplements that are primarily for the prevention of possible ill-health, or to counter the natural effects
of ageing. Malaria prophylaxis and vaccinations (except where stated in the Benefits Table), such as
travel vaccinations, flu vaccinations, epidemics and pandemics, and any other vaccinations
Second Opinion: The administrators of the Alliance Health Options fund may allow or require a second
opinion from a registered medical professional and reserves the right to submit for adjudication
conflicting opinions to the Medical Directors of Alliance Health Options for resolution.
Self-Inflicted Injury and Negligence: Any self-inflicted injury, needless self-exposure to peril (except in
an attempt to save human life), suicide or attempted suicide. If the member is involved, or participates,
in activities or habits against the advice of a medical practitioner, or counsellor, or against health and
safety regulations, where such involvement could lead to injury or harm. Members who require
treatment to remedy the effects of an attempted suicide are restricted to emergency medical services
and casualty for stabilization up to a maximum cost of $1,500 and for no more than 24 hours.
Septoplasty: Septoplasty and/or Rhinoplasty for the correction of a deviated septum except where such
surgery is required to correct damage which may have occurred in an accident that took place after the
member’s join date.
Sex Changes: any treatment directly or indirectly associated with sex changes or gender reassignments,
or consequences of such treatment unless associated with newly born infants and subject to the
benefits available to members under the New Born benefit. Please see Benefit #61.
Sleep-Related Breathing Disorders: Treatment for snoring, sleep apnea and other related conditions.
Travel and Accommodation Costs: unless specifically agreed by Alliance Health and only for treatment
received will be in-patient. Unless otherwise covered by your ambulance, or evacuation benefits.